| NPI | 1215227020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHEW JAMES SWENSON Sole Member 843-518-3701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 4694) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |